Finally a book that tells the truth about what
really happens when a woman has her baby in the hospital with a certified
nurse-midwife, CNM. Ivy-league-educated author Catherine Taylor, writes about
her own experience as a nurse-midwifery patient as well as stories of many
births she attended as an observer or doula.

What is most amazing about the stories of birth
that are retold is the author’s realization that the certified nurse-midwives
that the pregnant women trust are agents of the medical institutions. In story
after story, the CNM patients are mislead about what to expect of their birth
experiences.

Taylor shadowed a number of CNM’s during their
usual workdays at their hospitals. The CNM care frequently mirrored
physician–nurse care as busy CNMs left their clients in very active labor.
Claims one CNM, “We try to compensate by having a nurse attend them.” Yet while
a number of CNMs expressed a longing to be more actively involved with the women
they care for, none actually provided the women with hands-on, continuous care
during their labors and births. Taylor points out hospital-based CNMs frequently
provide inadequate midwifery care, failing to provide even a modicum of “human
presence” which is a core competency of the ACNM (American College of Nurse
Midwives).

In birth story after birth story the reader is made
aware of the inability of the CNM to prepare women for a drug-free, empowering
birth. Woman after woman believed the slick hospital promotions that shows the
beaming new mom and dad holding their little one with the ever-present staff
hovering nearby. The rude reality is that for most of the women, this was a
fantasy.

The midwifery clients were unprepared for the pain
of labor and what to do about it. The midwives were too busy running from
patient to patient to do more than stick their head in a room long enough to don
a glove and check dilation and make lame suggestions for dealing with pain. The
nurses also had no time to provide one on one support--that left the women and
their partners to go it alone, without having been educated about what to do.

One theme that is played out in many of these
stories is the power the hospital has over the CNMs. Whatever their personal
beliefs may have been, they inevitably acquiesced to the hospital administration
or physicians if there was friction between what a client/patient wanted. A few
of the examples given include handing out “goodie” bags loaded with formula
while theoretically promoting breastfeeding; telling a woman she needs pitocin
when it is actually being given to speed up labor for the staff’s benefit; and
breaking a water bag for the physician’s convenience.

Many CNMs seem to relish their role as mini
physicians. IVs, rupturing membranes, ordering antibiotics, pitocin and
epidurals, cutting episiotomies and dragging babies out by suction vacuum are
daily activities for hospital-based CNMs. Yet the ACNM claims that one of the
primary characteristics of a midwife is as an advocate “of non-intervention in
the absence of complications.” With the widespread use of routine interventions
by CNMs, one has to wonder whether any of the ACNM publications can be trusted.
Said one CNM to a VBAC client, “With the next baby, if the baby starts to look
big, my preference is to induce a week early. You’re so tiny you might have to
have a c-section for all your babies.”

Do CNMs educate their clients better than
physicians so that when interventions are offered, they are able to make fully
informed decisions? Taylor wonders about this too and asks, “Can parents in the
middle of the unfamiliar and often disorienting experience of labor make good
decisions?” Can parents really be fully informed when a CNM has to please her
collaborating or supervising physician or comply with hospital protocol in order
to keep her job? Too often it seems, they side with those who sign their
paychecks.

Some women have been able to hire doulas to provide
the emotional support and unbiased information about hospital interventions.
Sadly this is not always what they thought they were getting either. As Taylor
points out, doulas are trained to never be critical. This means that if a woman
suddenly decides she wants drugs during her labor, the doula supports her. Like
CNMs, doulas frequently find they must walk a fine line to be welcome in a
hospital. Sometimes this may mean not advocating 100% for the woman but rather
guiding her to comply with some unnecessary intervention that will soothe the
staff and keep the doula in their good graces.

Taylor discovered that at one hospital, the
majority of CNMs had homebirths. She attended a number of homebirths while
researching this book as well as at Elizabeth Gilmore’s birth center in New
Mexico. Taylor chose to have her second child born at home. After her less than
satisfactory first birth, Taylor explains that at home the woman’s ability to
birth is protected rather than controlled. This is what Taylor wants. This is, I
believe, the primary reason women in America choose to have a homebirth.

Taylor’s emotional process of going from a hospital
birth to a homebirth is somewhat detailed in this book. Those of us who have had
home births know exactly what she is dealing with when explaining her homebirth
decision to those who only believe in hospital birth. She writes, “I realized my
friend’s viscerally negative reaction to homebirth was probably not based on
some piece of knowledge or information, but rather on ungrounded fears.”

While an ideal arrangement for birth is to have
supportive medical care at the ready in case of an emergency, most homebirth
families and midwives find this very difficult to obtain. Unlike a great many
American women, Taylor had insurance while pregnant with her second baby and
utilized that insurance to buy back-up medical care her CNM was unable to
provide. While physicians decry those who plan homebirths without medical
back-up, these physicians increase the dangers of homebirth by refusing to
provide the very care they believe is essential for safety. Like Taylor, who
pretended to plan a hospital birth in order to have emergency medical care
readily available, those with money can buy a safety net. The rest cross their
fingers or pray.

Taylor’s praises Elizabeth Gilmore’s Taos, New
Mexico free-standing birth center. The practice employs obstetricians who
provide built-in back up for the midwifery clients. Clients can choose to birth
at home or the birth center. Although seemingly idyllic, the birth center has
been a labor of love for Gilmore who has worked ceaselessly to keep it viable.
The politics of birth are everywhere an endless war.

This book was written because Catherine Taylor had
to write about her birth experience. Like so many of The Complete Mother
subscribers, her homebirth transformed her into a strong, self-assured mother
and woman. Those of us who have been there and done that will smile that knowing
smile while reading of her metamorphosis. It’s the secret knowledge that’s
suddenly discovered that we had the power all along, but didn’t know it.

Taylor recognizes that the road to self-discovery
is frequently full of pain and vomit and body fluids. “Yet it was one of the
most vital and powerful moments of my life…my midwife did not just attend the
birth of my baby; she attended the birth of a new, powerful, confident and
loving part of myself.” Amen.